Vedere nel paziente una persona. Una nuova prospettiva per i servizi sanitari

Disponibile al link: http://saluteinternazionale.info/2009/03/vedere-nel-paziente-una-persona-una-nuova-prospettiva-per-i-servizi-sanitari

Strumenti e metodi per misurare la patient satisfaction nei sistemi multidimensionali di valutazione della performance in sanità.

Introduzione Negli ultimi anni le organizzazioni sanitarie - sia a livello internazionale che nazionale e regionale – hanno adottato sistemi multidimensionali per la valutazione della performance dei servizi sanitari. Accanto ad indicatori clinici ed economici, viene considerata la patient satisfaction per offrire una nuova prospettiva di analisi agli stakeholders del sistema (policemakers, management e operatori sanitari). Con queste premesse, numerose indagini sono state condotte per conoscere e analizzare le determinanti della soddisfazione rispetto all’esperienza vissuta dagli utenti con i servizi e per comprendere quali azioni intraprendere per migliorarla. Occorre però chiedersi quanto siano validi e affidabili gli strumenti utilizzati per indagare l’esperienza degli utenti, poiché spesso è stata riservata una scarsa attenzione agli aspetti di validity e reliability, che risultano invece essenziali per dare credibilità ai risultati raccolti. Obiettivo Questo studio descrive lo sviluppo e il processo di validazione di un questionario sulla soddisfazione degli utenti dei servizi di medicina territoriale (medici di medicina generale – MMG, pediatria di libera scelta – PLS, specialistica e diagnostica ambulatoriale) applicabile nel contesto italiano. Metodo Il questionario oggetto di studio è stato costruito dopo aver ricercato nella bibliografia esistente le principali dimensioni misurate dai questionari sull’assistenza territoriale, adattando al contesto italiano gli items utilizzati nelle esperienze internazionali. Nel gennaio 2009 il questionario è stato somministrato nel corso di un’indagine (condotta con metodologia Computer Aided Telephone Interviews) rivolta ad un campione casuale di cittadini liguri che negli ultimi 12 mesi avevano avuto accesso ai servizi di medicina generale, pediatria di libera scelta, specialistica e diagnostica ambulatoriale presso le strutture delle aziende sanitarie liguri. Attraverso l’analisi fattoriale, il coefficiente di correlazione e l’alfa di Crombach si è voluto esaminare la relazione esistente tra gli items introdotti nel questionario e la loro affidabilità come misure di patient satisfaction con i servizi territoriali. Risultati L’analisi psicometrica condotta sulle dimensioni ha riportato evidenze positive sulla validità e affidabilità dello strumento. In particolare, l’analisi fattoriale ha confermato la sussistenza delle dimensioni in cui il questionario è stato strutturato producendo 4 fattori (loading>0.40) che corrispondono alle dimensioni: MMG (fattore1), specialistica ambulatoriale (fattore2), PLS (fattore3), diagnostica ambulatoriale (fattore4). Il coefficiente di intercorrelazione tra i singoli fattori (medicina territoriale, patient experience, questionario, validazione

Applying logistic regression analysis to identify patient’s satisfaction predictors with general practitioner assistance: evidence from four Italian regions.

In the last years the interest for patient experience with health care services largely increased. Several surveys have been conducted in order to observe if health care systems answer to the overall patient needs. In 2000 World Health Organization challenged modern health care providers to ensure responsiveness to patients, i.e. to deliver also non-health assistance (respect for dignity, confidentiality, prompt attention, quality of amenities, access to social support networks, choice of provider, etc.). Poor evidence is available in Italy about connections between perceived quality and the capability of the healthcare system to respond to patients’ needs. This work aims at investigating patient experience with General Practitioner (GP) assistance and at measuring the impact of personal and organizational characteristics on overall satisfaction and on willingness to recommend. In 2009 a sample survey was conducted in four regions of Italy (Tuscany, Piedmont, Umbria, and Liguria). About 15.000 citizens answered to a large questionnaire related to Primary Care services, including a section dedicated to General Practitioner (GP) assistance. A logistic regression analysis was applied to analyze which are the predictors of overall satisfaction with GP, focusing mainly on variables related to patient’s expectations, continuity of care and organizational aspects (e.g. scheduled access, waiting time, health case history, etc.) and if there are differences across the four Italian Regions. Econometric analysis has been carried out through both ordered logistic regression and generalised ordered logit models. The inhabitants of the four Italian Regions refer a nice experience with GP assistance: more than 85% of them judged excellent or good the overall service. Generally, in some regions patient expectations affect more the willingness to recommend GP to friends or family members than the overall judgement on service. Besides, the findings provide convincing evidence that GP is a nodal point in the continuity of care process .: patient satisfaction, general practitioner, organizational aspects, continuity of care

Performance assessment in the maternity pathway in Tuscany Region

The paper describes the performance measurement system of the maternity pathway used in Tuscany by health care professionals, general managers and regional policy-makers. This system uses 19 indicators grouped in six dimensions: population’s state of health; compliance with regional guidelines; efficiency and financial performance; clinical and health assessment; patient satisfaction; and employees’ satisfaction. The results are represented on a spider diagram that summarizes the results on the different dimensions. The Tuscan performance measurement system of the maternity pathway has been used to identify best practice within, and their adoption throughout, the Tuscan public health care system

Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in Italy

Background: Several countries have co-located General Practitioners (GPs) in Primary Care Centres (PCCs) with other health and social care professionals in order to improve integrated care. It is not clear whether the co-location of a multidisciplinary team actually facilitates a positive patient experience concerning GP care. The aim of this study was to verify whether the co-location of GPs in PCCs is associated positively with patient satisfaction with their GP when patients have experience of a multidisciplinary team. We also investigated whether patients who frequently use health services, due to their complex needs, benefitted the most from the co-location of a multidisciplinary team. Methods: The study used data from a population survey carried out in Tuscany (central Italy) at the beginning of 2015 to evaluate the patients’ experience and satisfaction with their GPs. Multilevel linear regression models were implemented to verify the relationship between patient satisfaction and co-location. This key explanatory variable was measured by considering both the list of GPs working in PCCs and the answers of surveyed patients who had experienced the co-location of their GP in a multidisciplinary team. We also explored the effect modification on patient satisfaction due to the use of hospitalisation, access to emergency departments and visits with specialists, by performing the multilevel modelling on two strata of patient data: frequent and non-frequent health service users. Results: A sample of 2025 GP patients were included in the study, 757 of which were patients of GPs working in a PCC. Patient satisfaction with their GP was generally positive. Results showed that having a GP working within a PCC and the experience of the co-located multidisciplinary team were associated with a higher satisfaction (p < 0.01). For non-frequent users of health services on the other hand, the co-location of multidisciplinary team in PCCs was not significantly associated with patient satisfaction, whereas for frequent users, the strength of relationships identified in the overall model increased (p < 0.01). Conclusion: The co-location of GPs with other professionals and their joint working as experienced in PCCs seems to represent a greater benefit for patients, especially for those with complex needs who use primary care, hospitals, emergency care and specialized care frequently

L’esperienza dei cittadini del servizio di medicina generale: come la comunicazione influenza la relazione medico – paziente. Quattro regioni a confronto.

Background La letteratura internazionale evidenzia che la relazione tra medico e paziente influisce sulla valutazione complessiva dei servizi sanitari. Obiettivi Il paper si concentra sull’assistenza offerta dai medici di famiglia (MMG) e si propone di analizzare come la comunicazione tra medico e paziente influenza la soddisfazione complessiva a seconda del profilo socio-demografico dell’utente. Metodologia Nel 2009 è stata condotta un’indagine campionaria sui servizi di medicina territoriale. Oltre 15.500 cittadini assistiti in Liguria, Piemonte, Toscana ed Umbria hanno risposto ad un questionario somministrato telefonicamente. Sui dati sono state condotte analisi descrittive e applicati modelli di regressione semplice. Risultati e conclusioni: La soddisfazione complessiva per il servizio offerto dai medici di famiglia è elevata: in media oltre l’85% dei cittadini esprime una valutazione positiva. È risultato inoltre che alcuni elementi della comunicazione medico-paziente condizionano positivamente tali giudizi, con differenze significative per età, sesso, titolo di studio e stato di salute percepito dei rispondenti. La responsiveness dei medici di famiglia deve perciò tenere sempre più conto anche delle differenti e crescenti aspettative dei pazienti.soddisfazione pazienti, medicina generale, relazione medico-paziente

Patient-perceived responsiveness of primary care systems across Europe and the relationship with the health expenditure and remuneration systems of primary care doctors

Abstract Background Health systems are expected to be responsive, that is to provide services that are user-oriented and respectful of people. Several surveys have tried to measure all or some of the dimensions of the responsiveness (e.g. autonomy, choice, clarity of communication, confidentiality, dignity, prompt attention, quality of basic amenities, and access to family and community support), however there is little evidence regarding the level of responsiveness of primary care (PC) systems. Methods This work analyses the capacity of primary care systems to be responsive. Data collected from 32 PC systems were used to investigate whether a relationship exists between the responsiveness of PC systems and the PC doctor remuneration systems and domestic health expenditure. Results There appears to be a higher responsiveness of PC when doctors are paid via capitation than when they only receive a fee for services or a mixed payment method. In addition, countries that spend more on health services are associated with higher levels of dignity and autonomy. Conclusion Quality, as measured from the patient's perspective, does not necessarily overlap with PC performance based on structure and process indicators. The results could also stimulate a new debate on the role of economic resources and PC workforce payment mechanisms in the achievement of quality goals, in this case related to the capacity of PC systems to be responsive

Catching and monitoring clinical innovation through performance indicators. The case of the breast-conserving surgery indicator.

Background: The evolution in the surgical and diagnostic procedures, the attention to women’s preferences, the case mix, and di erences in professional practices may lead to a variability in the quality of breast cancer clinical pathway. To catch and manage this variability it is important to use valid measures. The aim of this paper is to examine the concurrent validity of the breast-conserving surgery (BCS) indicator and to provide evidence to guide the quality improvement process. Methods: The BCS indicator was calculated using hospital discharge records (HDRs) and was validated against surgi- cal registry (SR) data in a random sample of 336 women undergoing breast cancer surgery in 2012 in two Tuscan teaching hospitals. The concurrent validity of BCS was examined by cross-tabulating patients using the ICD-9 CM codes for breast surgery obtained from the two data sources. Results: The analysis, carried out involving breast cancer professionals, highlighted that the large majority of inter- ventions coded as “mastectomies” in HDRs are in fact reconstructing procedures, including nipple-sparing, skin- sparing and skin-reducing mastectomies in SR. These results led us to re ne the old algorithm, that calculates the proportion of breast-conserving surgery over the total number of breast interventions, and reclassify breast cancer surgical procedures into three categories: conservative, reconstructive and traditional mastectomy. Based on this new classi cation algorithm, the percentages of (I) reconstructive interventions were 16% at Florence TH and 38.3% at Pisa TH; (II) breast-conserving interventions were respectively 72.8 and 52.1%; and (III) mastectomies 11.2 and 9.6%. After adjusting for age in a logistic regression model, the percentages of reconstructive interventions at Florence and Pisa were respectively 22 and 34% and those of breast-conserving interventions 63 and 53%. Conclusions: Our results indicate that breast cancer care indicators should be re ned by distinguishing reconstruc- tive procedures (nipple/skin-sparing surgery with implant or breast tissue expander insertion) from traditional mas- tectomy. The involvement of breast care professionals in the choice of indicators proved to be crucial to capture the up-to-date breast cancer surgical practice and inform the quality improvement process. Keywords: Performance indicators, Breast cancer, Breast conserving surgery, Healthcare quality, Professional involvemen